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Study recommends shorter hospital stays for heart attack patients

Hospitals could safely move toward releasing heart attack patients without complications after just three days, instead of the usual five or six, a team of researchers suggested on Thursday.

Their cost-benefit analysis, laid out in the New England Journal of Medicine, sharpens an already touchy medical debate. Shorter stays for heart attacks could raise a public outcry like the one that gave rise to a 1998 federal law mandating at least two days of insurance coverage for maternity stays, doctors said.

Marty Ann Schwartz, who wrote ''Listen to Me, Doctor: Taking Charge of Your Own Health Care,'' said she fears insurers will seize on such cost-benefit studies to rush patients out of the hospital. ''They're trying to make up a sheet that the people ... can look at and say, 'It's five days, we cover three days, and it's disallowed.'''

Hospital stays have shrunken drastically for heart attacks since the 1950s, when doctors believed patients needed such care for four to six weeks while the heart muscle healed. The latest analysis is apt to push the industry toward even shorter stays, according to its chief author, Dr. Kristin Newby.

Newby of Duke Clinical Research Institute in Durham, N.C., joined researchers at four other institutions in carrying out the study.

Reviewing records of 22,361 patients, the researchers calculated that very few -- perhaps as few as 13 -- benefited from a fourth day in the hospital. For an average patient, the fourth day yields only another two days in life expectancy.

Thus, at $624 a day in extra hospital and doctor costs, it would cost $105,629 for an additional year of life expectancy -- more than double the $50,000 figure for kidney dialysis. The kidney procedure is widely used as a benchmark for deciding if medical care is worth the social benefit.

Overall savings from shorter heart attack stays could be considerable, since more than 1 million Americans suffer heart attacks each year. About 60 percent have no complicating conditions, Newby said.

However, she acknowledged that most hospitals aren't yet set up to give patients all the pre-discharge testing, rehabilitation and advice they may need within three days.

''This is really outlining a possibility, if we could make our system more efficient,'' said Newby.

Dr. Donald Young, medical director of the Health Insurance Association of America, said the study raises points that should be considered. ''Health care dollars are limited, and we need to know what works and what doesn't work,'' he said.

While also welcoming the study, some doctors extended cautions. They said it is very difficult to decide which patients are at highest risk.

Cardiologist Lynn Smaha, president of the American Heart Association, said he felt ''mixed feelings'' about the analysis. ''We're all trying to do what we can to reduce the cost. At the same time, we have to keep up the quality of care. Cost should not be the prime motivator,'' he said.

He said the conclusions of the analysis may be muddied by the fact that the patients did receive the fourth day of hospital care -- and possibly benefits that are hard to quantify.

In an editorial in the same journal, Boston-based doctors Elliott Antman at Brigham and Women's Hospital and Karen Kuntz at Harvard School of Public Health question if there is enough evidence for the safety of pre-discharge stress testing within three days of a heart attack. Such testing monitors the heart's recovery by putting the patient on a treadmill.